COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE in VS .NET

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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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The best-known ingredient of coffee, caffeine is found naturally in the leaves, seeds, or fruits in several plants, and is present in tea, chocolate, soda, and other products Consumed in popular beverages such as coffee and tea, caffeine or its metabolites are thought to confer significant anticarcinogenic and antioxidant properties103 106 For example, a 23-week period of oral administration of green tea or black tea to SKH-1 mice at high risk of developing skin cancer because of twice weekly exposure to UVB (30 mJ/cm2) yielded a lower incidence of tumors/mouse, decreased parametrial fat pad size, and decreased thickness of the dermal fat layer away from and directly under tumors Decaffeinated teas exhibited little or no effect, but the restoration of caffeine restored the inhibitory effects107 Significant anticarcinogenic activity has also been displayed through the topical application of caffeine to SKH-1 hairless, tumor-free mice pretreated with UVB twice weekly for 20 weeks108 In topical products (eg, La Roche-Posay Rosaliac and Replenix Cream CF), caffeine is an effective anti-inflammatory and constricts veins to reduce facial flushing The anti-inflammatory and anticarcino-
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The stem of the pineapple plant, Ananas comosus, is the source of bromelain, a term used to designate its constituent family of sulfhydryl-containing proteolytic enzymes98 It is indicated for cutaneous purposes because of its antiinflammatory properties, although it is usually administered orally to aid diges-
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use in the morning, typically 200 mg Individuals taking cholesterol-lowering statin drugs should be counseled to consider this supplement, as statins reduce natural CoQ10 levels Low CoQ10 levels are associated with fatigue and muscle cramping Those on cholesterol lowering drugs should consider taking 400 mg every morning
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Derived from the seeds of evening primrose (Oenothera biennis), a hardy biennial member of the Onagraceae family noted for its fragrant flowers that open at dusk during the summer, EPO is an omega-6 fatty acid that contains both LA and GLA) In fact, it is one of the best sources of GLA, a polyunsaturated essential cis-fatty acid important in the production of prostaglandins, which play a role in the functioning of most bodily systems LA is used by the body to synthesize GLA In addition, LA imparts significant benefits to the skin, maintaining stratum corneum cohesion and reducing transepidermal water loss113 (see 11) Overall, though, the health benefits of EPO are attributed to GLA In a double-blind trial assessing the effects of oral EPO on atopic eczema, researchers found a statistically significant improvement among the EPO patients in overall severity of symptoms, including reductions in percentage of body surface involvement, inflammation, xerosis, and pruritus While patients receiving placebo experienced less inflammation, EPO patients demonstrated a significantly greater reduction and a significant increase in plasma levels of dihomogammalinolenic acid114 Consequently, some authors have speculated that supplementing with products high in GLA, such as EPO, may be effective for patients with atopic eczema115 EPO taken as an oral supplement is judged a valuable source of essential fatty acids It is approved in Germany for eczema and PMS and other uses In 2004, it was found in a survey of more than 21,000 adults to be the most commonly used oral supplement116 In addition, EPO combined with zinc has been used to soothe dry eyes, ameliorate brittle nails, and to treat acne and sunburn Overall, this supplement may be effective in helping to hydrate the skin, as well as easing inflammation and irritation The author particularly recommends EPO to patients who experience frequent skin irritation
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are also available), glucosamine and its derivative N-acetyl glucosamine are amino-monosaccharides that serve several significant biological roles, particularly in the production of cartilage Both act as substrate precursors for hyaluronic acid (HA) as well as proteoglycans synthesis Given its role in HA production, it is not surprising that glucosamine has been demonstrated to confer various cutaneous benefits, such as enhancing hydration, reducing wrinkles, and accelerating wound healing117 In addition to anti-inflammatory and chondroprotective properties, glucosamine has been shown to be effective in treating hyperpigmentation because it inhibits tyrosinase activation thereby suppressing melanin synthesis117 In a randomized, controlled, single-blind 5-week study with 53 female volunteers who were given an oral supplement containing glucosamine, amino acids, minerals, and various antioxidant compounds, investigators found a statistically significant reduction (34%) in the number of visible wrinkles and a reduction (34%) in the number of fine lines in the treatment group as compared to the 12-person control group118 Oral glucosamine supplementation has also been demonstrated to ameliorate symptoms and decelerate the development of osteoarthritis in animals as well as in clinical trials in humans, and its list of indications is expanding117 In a retrospective survey of the nonvitamin, nonmineral dietary supplements used among an elderly cohort between 1994 and 1999, glucosamine emerged as the most frequently used supplement119 The author recommends 1500 mg/d, particularly to patients older than 35 years Glucosamine supplements have been demonstrated to assist in rebuilding cartilage, in which HA is an important component Evidence suggests that the effects of glucosamine supplementation, namely, increased skin fullness and decreased wrinkles, can be seen in as little as 4 to 6 weeks
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trials of oral HCSE for patients with chronic venous insufficiency in Medline, EMBASE, BIOSIS, CISCOM, and the Cochrane Library (until December 1996) found that HCSE was superior to placebo in all cases120 In addition, they noted reductions in lower-leg volume, leg circumference at the calf and ankle, and improvement in symptoms including leg pain, pruritus, fatigue, and tension, with only rare mild adverse reactions The same investigators, along with a third, subsequently conducted a broad database search of Medline, EMBASE, the Cochrane Library, CISCOM, and AMED (until October 2000) on complementary and alternative medicine and found additional cogent evidence for the effectiveness of oral HCSE for the treatment of chronic venous insufficiency121 HCSE has been proven to improve inflammation and circulatory discomfort in its oral form Patients taking anticoagulant drugs should be advised not to supplement with HCSE
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